DG's Official Visit Memo

RI Dist. 3170             Name of DG: Rtn. Dr. Jorson Fernandes

Add: “Villa Shanti Niketan”, Mokim, Cuncolim, Salcete, Goa , India – 403703

Tel: 0832-2763347 / 2733334, Mob: 09822101334 E-Mail: drjorsonferns@gmail.com

District Governor’s Official Club Visit Memo            Format -2     Page 1 of 12

Name of the Club: _________________________________Date of Visit: ________________________
 Name of Asst. Governor: _________________________________________                                                        

1) President and Secretary’s Meeting:-

Designation	Name & address, Tel Nos., E-Mail	Signature
President of the Club 2012-13	Name:___________________________________________ Address:__________________________________________ _________________________________________________ _________________________________________________ Tel. Nos:_________________________________________ Mob:___________________________________________ E-Mail:__________________________________________
Secretary of the Club 2012-13	Name:___________________________________________ Address:__________________________________________ _________________________________________________ _________________________________________________ Tel. Nos:_________________________________________ Mob:___________________________________________ E-Mail:__________________________________________
President of the Club 2013-14	Name:___________________________________________ Address:__________________________________________ _________________________________________________ _________________________________________________ Page 2 of 12   Tel. Nos:_________________________________________ Mob:___________________________________________ E-Mail:__________________________________________
Secretary of the Club 2013-14	Name:___________________________________________ Address:__________________________________________ _________________________________________________ _________________________________________________ Tel. Nos:_________________________________________ Mob:___________________________________________ E-Mail:__________________________________________
Treasurer of the Club 2012-13	Name:___________________________________________ Address:__________________________________________ _________________________________________________ _________________________________________________ Tel. Nos:_________________________________________ Mob:___________________________________________ E-Mail:__________________________________________
Asst. Governor	Name:___________________________________________
Special Invitee if any (GSR/Mentor)	Name:___________________________________________ Address:__________________________________________ _________________________________________________ _________________________________________________ Tel. Nos:_________________________________________ Mob:___________________________________________ E-Mail:__________________________________________

Club Service:-                                                                      Page 3 of 12

a)Communications from District and to the District:        Excellent /  Good/ satisfactory

                                  Any suggestions: _______________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
b)Club Charter Date _____________________________ Charter No: __________________

c)Charter Day / Nite celebration date: _________________

d)Name of Historian of the Club: ________________________________ E-Mail:___________________

e)Club Bulletin Name: ___________________________(Weekly/Monthly/Quarterly/Yearly)

f)Club Assemblies Conducted for 2012-13 dates: ______________, ________________, _____________,
________________, ________________, ______________.

g)BOD Meetings conducted for 2012 -13 dates: __________________, ______________, ____________,

___________, ______________, _______________, ____________, ___________, ____________

h)Strategic Planning Meeting of Club held on :___________________, Minutes maintained:  Yes/No
    Strategic Plan of the Club reviewed on :_______________

Compliance Report if not done by ______________(Date)
DCC Strategic Plan of the region marked the action to assist the club with concerned AG

i)Club Action Book maintained Yes / No, updated by historian on : __________________

j)Member Access registered by the President: Yes / No
Compliance Report: if not done then DCC New Technology and AG to assist by ______________(Date)

k)Annual Gen. Body Election Meeting of the Club fixed on/ held on _________________(date)

l)Information to world HQrtrs through Member access to upload information of President and secretary for the world directory  done on __________________(Date)
m) Check list of documents to be made available for the DG’s Visit:

S.No.	Checklist for President’s and Secretary’s Meet	Available	Not available	Compliance Action marked to:
01	Club Charter
02	Manual of Procedure
03	RI Directory (Book / DVD)
04	Club Constitution and ByLaws adopted on _______
05	President’s and secretary’s work book manual filled
06	a)Audited Acts of 2011-12/ previous years file maintained b)Annual budget for 2012-13 / Annual budget file maintained
07	Classification roaster updated on _____________
08	List of PHFs, RFSMs Updated position of balances List of major donors
09	Name list of prospective PHFs, RFSMs and major donors
10	B.O.D. Minutes book
11	Club Assembly Minute Book
12	Weekly Meeting Minute Book
13	Attendance Register for weekly meetings
14	Special Mailing List of Club maintained
15	Visitors’ Book maintained for events
16	a)List and addresses of Club Members with Tel. Nos. and e-mail IDs b) List of Dist. Officers from the Club
17	Strategic Planning File
18	Planning Guide for effective Clubs duly filled and signed by President, secretary and AG
19	Membership Goal form
20	TRF Goal form
21	Club Plans & Objectives for 2012-13
22	Club Committee Plans CLP Committees Avenues wise Sub Committees
23	Information on Permanent projects
24	Copies of SAR-1 sent on _________ for ______Mem Copies of SAR-2 sent on _________for ______Mem Fees to Rotary News sent on _______ for ____ mem Fees towards Dist. Fund sent on ______for ___mem
25	Club Publication file maintained
26	TRF Annual giving file maintained
27	Matching grant file maintained
28	Club dues file maintained SAR file maintained Rotary news dues paid file maintained Dist. Fund dues paid file maintained
29	a)Club action Book maintained b)Club Membership Register / Roaster(could be part of Club action Book) c)Awards received by the Club
30	a)Trust Deed b)Names of Trustees:

Page 4 of 12

Administration:-                                                                                        Page 5 of 12

a) Membership details:

* Membership   less than25   / more than25 

New Member Information kit given / not given
Orientation of new members conducted on ____________(date)

Membership	Numbers	Membership Goal of RI and District met with:	Compliance report action marked to: DCC MDR of the region.
Membership as on 1-7-12
Members added
Members resigned
Members terminated
Total number of members as on date
Honorary members
Membership dues sent to RI for

b)Financial obligations of new members :

_______ New members, RI dues paid by ______ members, Subscription to “The Rotarian by ____members,to Rotary News/Rotary Samachar by _____members, Dist. Fund paid by _____ members towards TRF paid by ______ members

c)Financial obligations of members:

No. of members	Amt. per Rotarian	Paid to	Balance to be paid	Back log of RI dues	Back log of RNT dues	Compliance report by:
		RI 1st. half 2nd half
		Rotary News trust
		Dist. Fund

d)Attendance for weekly Meetings on an average is ________
compliance action marked to: ____________________________________
Meetings to be interesting to members:_____________________________________________
e) Partners –in-service

Associations	No. of Clubs	Membership strength	Address and Tel Nos. of President	Compliance report if any by:
Interact
Rotaract
RCC
Innerwheel
Rotakid
Probus Clubs(Optional)

f)Dist. And Revenue Dist. Events organized/ Hosted:

Sr. No	Name of the event	Organised on (Date), event Chairman name:
01		Date: Name of event Chairman:
02		Date: Name of event Chairman:
03		Date: Name of event Chairman:
04		Date: Name of event Chairman:

g)Effective Club:-

S. No	Criteria for effective Club	complied with	Compliance report
01	Directors for 5 avenues of service appointed	Yes / No New Generation service  Director appointed
02	Club Leadership Plan adopted on(date)	Date: Memb. Dev. Comm. Chair:____________________ Club PR Chair:______________________________ Club Adm. Chair:____________________________ Service Projects Chair:________________________ TRF Chair: _________________________________
03	Sustained membership
04	Increase in membership by 3%	Complied for ______ members
05	Implemented service project to meet needs of Community	Name of the project:_______________________ ________________________________________ Conducted on:________________________
06	Support  TRF	Contributions:______________________ Participation:______________________________ _________________________________________
07	Leaders beyond Club level	Number: ________

Page 6 of 12

h)Training:-                                                                                                                                               page 7 of 12

Programme	Date	Members / Youth	Beneficiaries reaction
RYLA conducted
RYLA attended
R.L.I attended
TOTS attended
Club L-Ship Prog attended
Dist. L-Ship Prog attended
Speech Craft attended
3R Rotary – Wochardt Prog
Triage Officer Prog. On Disaster mgmt.
Rotary Institute
Pre-PETS
PETS & SETS
Dist. Assembly
DTTTS
AGTS
Memb. Dev. Seminar
Polio Plus Planning Workshop
TRF Seminar

 Vocational Service:-

a)Vocational Awards:- (Three Outstanding Persons)

1. Outstanding Women Entrepreneur: ______________________________________________

2. Outstanding Differently -abled Entrepreneur: ________________________________________

3. Outstanding Sports personality:_________________________________________

b) Career Awareness Programme conducted on ________ date for ____no. of beneficiaries

c)Supported the career awareness VDO by identifying Institutions from the region:-

Name  and Address of the Institution	Contact Person Tel Nos.	Faculty available

d) Earn while you learn programme introduced in _______ (Number)organizations having ______ vacancies, for ________ beneficiaries.

e) Four Way Test promoted to _________________ no. of beneficiaries.

Four Way Test	Institution / Community	No. of beneficiaries
Hoarding
Book Time tables
Book Labels
Book Covers
Umbrellas with 4-Way test
T-Shirts
Meetings

Community Service:-

Projects	Date	No. of Beneficiaries
TB Control Prog.
Maternal & Child Health
Adult Education
Computer Literacy
Vocational Training
Water and sanitation
Community Development
Project for Sp. Children
Blood Donation
Environmental Protection
Projects with RCC
Projects with Rotaract
Project with Interact
Project with Innerwheel
Project with Rota Kid
Project with Probus Club
Project on Disease Prev. & Control
Peace Conference conducted
Peace Conference attended

Page 8 of 12

Page 9 of 12

International Service

1. The Rotary Foundation:-

a)Polio Immunisation promotional activities

Promotional activity	Conducted on (date) quantum of people reached
NID 1st
NID 2nd
Polio Road Show
Media awareness Radio Print Media Mass Media
Lectures
Routine Immunisation booth maintained at __________________________________	Routine immunisations conducted on ___________ ____________ reaching ____ Community on an average
Any other activity

b)Group Study Exchange

Incoming team hosted by ___________________________________ (Name of the member)

Outgoing team :Team member sponsored : _________________________________________
Team Leader sponsored : ___________________________________

c)TRF Contributions: TRF Goal for the year 2012-13: _____________________________________________

To:	Amount in $ / INR	Compliance Report  by ______
Annual Giving
Permanent Fund
Major Gifts
Bequest society
Benefactor
Paul Harris Society
Matching Grants
EREY
RFSM
Rotary Foundation Coupons
PHF / Multiple PHF

d)Matching Grants Ongoing Project:                                                                                       page 10 of 12

MG Project NO:		Action marked to for compliance	Action marked to for compliance at Dist. level
Partner
Project Cost
Status
Contact Primary
Contact Secondary
Interim Report sent on
Likely closure of the project by (Date)

Any suggestions or help from District: ______________________________________________________

_____________________________________________________________________________________

e) Matching Grant Completed: (Previous year / Present Year)
File closure / Final report sent on ______________________ due on _____________ date

Closure letter from TRF received on _____________________ due on _______________date.

f) Matching Grant (New Project)
Nature / Type: _____________________________________________________
Purpose/ Objectives: ___________________________________________________________________

__________________________________________________________________________________
Project Cost: _________________________Club Contribution: ___________________________
DDF from 3170: _______________ DDF from partrner Dist: No: ________ of ____________(amount)

Partner contribution: _____________, Any other: ___________________________

g)Dist. Simplified Grant:Obtained previously then give details: _________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Compliance completed / due on ______________
Details of New Project: ______________________________________________________
2)Dist. Conference and Convention to Lisbon

Registrations	Dist. Conference	RI Convention to Lisbon
Single
Couple
Children

Page 11 of 12

3)Int. Youth Exchange: Programme conducted for _______ members

4) Int. Fly. Exchange Programme conducted for _____ members  to ___________RI Dist.

5) Disaster Mgmt. support to _______ Club / ______ Dist. By _____ Volunteers / _______amount. Sent on ________.
New Generation Service

Name of the Project	No. of beneficiaries	Compliance action marked to
RYLA
Youth Dev. Project
Talent Search
Quiz
Skill Dev. Prog.

Presidential Citation Criteria:-

Criteria	Complied with	Non-Compliant	Action marked to:-
*EREY by 31-3-2013
*Net increase by 1 member
*85% min. retention
2% increase in qualified women membership
2% increase in qualified professionals (<45 yrs. Of age)
Induction of 1 or more TRF Alumni
Increased diversity

“*” marked are mandatory points, from the remaining 4 we must comply with 2.

 Rotary Public Image:

PR  Event	No. of people reached	No. of Institutions reached	New members sought in the Club	Compliance report
Orator of Dist. 3170
Rotary Wockhardt 3R Prog
R.I. PR Grant prpoject (Rotary Week)
Any other project

Awards:-                                                                                                               Page 12 of 12

Award	Nominee	Deadline to RI	Nominators	Name of Nominee
RI Presidential Citation	Rotary Club / DG	15th. Apr. 2013	DG 2012-13
Significant Achievement Award	Rotary Club	15th. March 2013	-do-
4-Avenues Citation award	Active Rotarian	15th. Feb. 2012	2012-13 Club Presidents
Rotary Award for world understanding and Peace	Non-Rotarian/ Non Rotary Organisation	1st. Nov. 2012	Any ActiveRotarian
Award for Rotary Foundation Alumnii	Rot. Foundation Alumnii		DG 2012-13

Awards won by the Club:-

Year	Name of the Dist. award

Club Assembly

Name	Designation	Signature with date
	President 2012-13
	Secretary 2012-13
	Asst. Governor 2012-13
Rtn. Dr. Jorson Fernandes	Dist. Governor 2012-13